NPIMap

Organization Active NPI

Advanced Dental Arts, LLC

  • Dental Clinic/Center
  • Macon, GA
National Provider Identifier
1679969380
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DN014686 Issued in GA
Legal business name
ADVANCED DENTAL ARTS, LLC
Practice address
4705 Northside Dr
Suite 100
Macon, GA 31210-1698
Phone
(478) 207-6939
Fax
(478) 254-9638
NPI assigned
Apr 9, 2015
Last updated
Apr 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samer Mufid Othman, D.D.S.NPI 1497001630
Title
Owner
Phone
(478) 207-6939

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DN014686 GA Primary

Addresses

Primary practice location

4705 Northside Dr
Suite 100
Macon, GA 31210-1698

Mailing address

4705 Northside Dr
Suite 100
Macon, GA 31210-1698
Phone (478) 207-6939

National Provider Directory

National Provider Directory

Locations

4705 Northside Dr
Ste 100
Macon, GA 31210
Phone (478) 207-6939

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1679969380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 NORTHSIDE DR",
            "address_2": "SUITE 100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101698",
            "telephone_number": "478-207-6939",
            "fax_number": "478-254-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 NORTHSIDE DR",
            "address_2": "SUITE 100",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101698",
            "telephone_number": "478-207-6939",
            "fax_number": "478-254-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DENTAL ARTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-09",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "OTHMAN",
        "authorized_official_first_name": "SAMER",
        "authorized_official_middle_name": "MUFID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-207-6939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN014686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.